Hip external rotation and extension angles for exposure and preparation of the proximal femur in direct anterior total hip arthroplasty: A cadaveric study

Academic Article


  • Introduction: The direct anterior approach (DAA) to total hip arthroplasty (THA) has a known learning curve, largely due to difficulty achieving exposure and visualization of the acetabulum and proximal femur for joint preparation. There is paucity of information on limb positioning and the degree of angulation at which the limb is positioned for adequate visualization. This study aimed to identify the mean angles of limb positioning necessary for adequate exposure when using two Mueller retractors for femoral preparation using traditional table. Materials & methods: A surgeon performed a DAA THA on 11 cadaveric hemipelves, exposing the femoral canal with two simple, robust Mueller retractors. The degree of external rotation and extension of the hip was measured. Results: Of the 11, the mean age was 77.6 years and mean BMI was 27.95. The mean external rotation angle was 56.5 ± 13.5°. The mean extension angle was 19.9 ± 6.6°. Discussion & conclusion: The key technical step in this study incorporated a second robust Mueller retractor on the posterior aspect of the greater trochanter, providing maximum leverage to deliver the femur and achieve visibility while reducing angles of limb positioning thereby reducing complications, and ultimately lessening the learning curve.
  • Authors

    Digital Object Identifier (doi)

    Author List

  • McGee AS; Huntley SR; Littlefield ZL; McKissack HM; Shah A; Naranje SM
  • Start Page

  • S62
  • End Page

  • S65
  • Volume

  • 11